Ward_X

Welcome! Learn all that you can, and take lots of notes . Eventually you will gain enough confidence to start contributing back to your lab. Help out where you can, volunteer to do the extra mile. Coming from another new MLS, I can acknowledge that our generation is brilliant, intuitive, and exquisitely savvy. However! We don’t know more than our coworkers who have been there for decades — use them!

In a grammatical sense, and from one who has studied Latin, isn't the usage dictated by the indirect object of the sentence? You're adsorbing bound antibodies to phenotypically known cell lines, and therefore interpreting the product that had antibodies pulled towards it. The whole point is to take off the antibodies (direct object) in a way you could identify them to selected RBCs (indirect object). Up for debate

@SMILLER and then how do you encourage staff improvement sans punishment based on your form process?

My facility seems to have a similar process in regards to gel screens. The only difference is that we perform the repeat screen before* proceeding to panels on patients with no previous history. Only when the repeat is positive or there is history is the panel performed. That ended up being a workflow decision that took some time to resolve, but moving to the performance of the tube screen first prevented gel-sensitive positives (that are only going to result as negative on panel) going straight to panel and getting fully worked up. As far as our result entry, positive gel screens do trigger an ABID test bar that has to be resulted. Our repeat screens in tube with negative reactions are resulted as No Antibody Detected (NAD), which keeps them EXM eligible. If the repeat screen is positive, and the workup moves to a panel, the ABID is resulted as the result of the panel. The repeat screen is billed as a "subsequent antibody screen with enhancement media," and we have two billing codes for standard panels (one billing for panels with 3 or less cells, and one billing for panels with 4 or more cells). TL;DR: Perform gel screen If positive... Does the patient have a history of antibodies? YES... proceed to panel rule-out. NO... proceed to step 2. If negative... result as negative. Perform PEG screen If positive... proceed to panel rule-out. If negative... result as NAD. Basically, the NAD to me seems like a dummy negative result to file. It means like a, "hey we did some reference work to see if there was anything, but there wasn't, but because we did a little more than just routine we can't just call it negative." Oh well.

I will preface my reply by saying I am not in a managerial position, just a tech in the lab. My facility has "Occurrence Reports" that record intentional deviations, reported errors, any workflow influence, etc. You can write them anonymously online or by hand. It's helpful at some points, but there's a fine line between people filling them out to report coworkers for silly things, or just filling them out when they feel "inconvenienced." I have a few problems with this process, but the form itself is outlined decently enough. It mainly just records the time a deviation is recorded, what area of the lab, what happened, corrective action, and future flow. Overall, I would say it comes down the culture of your lab. Who takes responsibility, and who places blame? If it's a workflow adjustment or something that takes less than 5 minutes to explain, or doesn't affect a patient in any way, emphasize communication between techs and talking to individuals directly to fix process kinks. Doing a whole roundabout where you report it and they find out weeks later about it through a form -- it's a little off-putting and not direct enough for cause and effect adjustment. If it's a real punitive-required situation, that's another problem. Complacency, which seems to be your mention, is something that starts to get into warnings, re-training, responsive action. If someone keeps incorrectly doing a test "their" way, force a re-train (people will want to avoid a whole session of teaching them how to do something they already know how to do, so maybe that's incentive).

Blood Bank abbreviations start to ruin everything

My facility uses HCLL 2016. If a type has to be manually edited or adjusted, the type turns red and they're no longer EXM eligible until the type "discrepancy" is resulted -- which, has to be corrected by a senior technologist. Logic wise, the software is missing two matching blood typings that would allow the patient to be electronic crossmatch eligible.

Independent entities. For example, if a sample is pending an eluate, but the screen is negative, you can still EXM.

The 16th manual does say that, yes, but it seems like an outdated guideline as this limitation does not exist in following publications. I would just stick to the latest edition and keep to what it says in the Whole Blood Processing chapter. The two most recent publications do not have as specific of a definition anymore.

I skimmed the AABB Technical Manual (18th Edition) and read: "5 days from date product was thawed or original expiration, whichever is sooner." --> pg. 19 Storage, Processing, Distribution, and Inventory chapter. However, I also saw that there being no strict definition may be because thawed plasma is not licensed by the FDA, according to a paragraph on pg. 221: "These products must be relabeled as 'Thawed Plasma' if they are stored for longer than 24 hours. Although not licensed by the FDA, Thawed Plasma is included in the AABB Standards for Blood Banks and Transfusion Services and the Circular of Information for the Use of Human Blood and Blood Components... expires 5 days after it was originally thawed..." Cryo is specified by the hour, so I would follow the logic that plasma is going by days (i.e. the midnight expiration) because it does not specify by hour like other products. Midnight is much easier

The AABB circulation booklet states, page 31, under Liquid Plasma Components: "...and maintained at 1 to 6C for up to 4 days after the initial 24-hour postthaw period has elapsed." Since the first 24hrs distinguishes between FFP, PF24, and PF24RT24, even the circulatory specifies days after this first period. However, their measures for coagulation factor activity and their corresponding data is all in terms of 120hrs. If it's any consolation, my facility uses the midnight deadline. I haven't seen anything about a product <72hrs dictating per hour, unless it's something like cryo? Even irradiated NICU units go out at midnight on the 3rd day from the irradiation date. Is there a current version of this floating around?

Piggybacking this comment that yes, the FDA dictates which adhesives can actually touch products meant for human consumption. A wise man once told me of specific CFRs (21CFR175.125 and 21CFR175.105) that detail said restrictions, so it's not as easy as just finding a new sticker that you can just slap on blood products after modifying them, unfortunately

We apply the 4x4 horizontally and wrap the bottom part of the sticker around to the other side of the aliquot.

True! I was once doing a workup that had both an ABO discrepancy and a positive screen, and they had to be treated as separate issues unless later proved related. Prewarming failed, so another tech following up after my shift had to use cord cells to clean up that mess. The antibody ended up being a non-specific CAA.

Seems unusual. I've only seen crossmatching the segments of the units that the pt ended up taking from the emergency release. Once our T/S is done we start sending type specific.